Welcome

Welcome to the POZ/AIDSmeds Community Forums, a round-the-clock discussion area for people with HIV/AIDS, their friends/family/caregivers, and
others concerned about HIV/AIDS. Click on the links below to browse our various forums; scroll down for a glance at the most recent posts; or join in the
conversation yourself by registering on the left side of this page.

Privacy Warning: Please realize that these forums are open to all, and are fully searchable via Google and other search engines. If you are HIV positive
and disclose this in our forums, then it is almost the same thing as telling the whole world (or at least the World Wide Web). If this concerns you, then do not use a
username or avatar that are self-identifying in any way. We do not allow the deletion of anything you post in these forums, so think before you post.

The information shared in these forums, by moderators and members, is designed to complement, not replace, the relationship between an individual and his/her own
physician.

All members of these forums are, by default, not considered to be licensed medical providers. If otherwise, users must clearly define themselves as such.

Forums members must behave at all times with respect and honesty. Posting guidelines, including time-out and banning policies, have been established by the moderators
of these forums. Click here for “Am I Infected?” posting guidelines. Click here for posting guidelines pertaining to all other POZ/AIDSmeds community forums.

We ask all forums members to provide references for health/medical/scientific information they provide, when it is not a personal experience being discussed. Please
provide hyperlinks with full URLs or full citations of published works not available via the Internet. Additionally, all forums members must post information which are
true and correct to their knowledge.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

There is a very strong bias in this forum toward overly hyping ever scientific advance, no matter how small or inconsequential. Any time someone dares to not go along with the Polyanna happy talk their posts are attacked as "lame, dellusional, pessimmistic" or something simliar.

It's almost like the regulars here don't want to hear anything other than "the end of HIV is right around the corner". I think it's dissingenuous to suggest that it is and to keep presenting every medical/scientific advance as if we were right on the brink of a cure (functional or otherwise) is misrepresentation at the very least.

We are a long way from the end. And that's not pessimism, that's reality. By any objective measure, that's reality.

I don't want to downplay the many advances that have taken place lately, because they are important, but the reality remains the same.

To clarify my earlier comments; If we were to chart the money spent for an HIV cure and the search for new drugs on a graph, the highwater mark on that chart will be the year they discover an HIV preventative vaccine. I don't see how you can argue that funding will remain constant, or increase, once the threat of new infections has been eliminated or drastically reduced. Now you can certainly debate how quickly the decline will occur, either rapidly or gradually over time, but to argue that it won't decline at all. Really?

HIV receives a disproportionate amount of funding in relationship to other diseases, based on the number of people afflicted, and I , selfishly think that that is a great thing. The rationalization for doing so is that without the additional efforts, HIV (since it's contagious) could mushroom into a much bigger problem than it already is now. But once a preventative vaccine is found, how do you justify the additional funding? There are already other disease constituancies that are jealous of the disproportionate amount of money spent on HIV - not to mention the political enemies who always oppose HIV funding. Plus, do you really think that corp. CEO's are going to invest tens or hundreds of millions of dollars to develope new treatments once the spigot of new customers ($$$$$) has been turned off? And again, I'm NOT saying ALL reasearch funding, but the decline in funding will begin.

I hope this whole debate becomes irrelavent when/if the vaccine that actually works to prevent, also works therapeutically.

But I still don't think expressing concerns about a solely preventative vaccine are totally misplaced.

As for Ann's comments about advocacy work, I wholeheartedly agree. I have done more than my fair share over the years, even before I was infected. I encourage those younger and healthier than I to follow suit.

« Last Edit: September 26, 2009, 04:32:12 PM by bmancanfly »

Logged

"The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt."

The article has web links including to an MP3 recording of a key conference call about the results.

Michael Palm reports that the likely effectiveness of the vaccine was somewhere in the range of 1.1% to 52.1%*, a wild variation -- especially considering a difference against the placebo of less than 1% would be is regarded as no difference at all.

So, did it work, or didn't it? hmmm

* 74 out of 8,198 volunteers who received placebo immunizations became infected with HIV compared to 51 out of 8,197 volunteers who received a combination of two vaccines, ALVAC vCP1521 and AIDSVAX B/E. Efficacy calculated at 31%, 95% confidence interval: 1.1%-52,1%, p value: 0.039. 7 volunteers were excluded from the efficacy analyses after it was found that they were HIV+ at the time of receiving their first vaccination.

I am going to answer your post, not to disparage your opinions but to clarify some facts that I believe were inaccurately assumed.

1. If you read what most posters actually say in this forum, I have never read where anyone claimed that a cure was around the corner as much as we all hope there will be. I do see a lot of optimism concerning up and coming therapies that are new and have the potential to be a breakthrough. I have not read any timelines given for a cure, only that there is a lot of potential and "thats a good thing".

2. No facts to my knowledge have been mis-represented ( please point out if I am wrong) they have just been stated with the hope of further development in a positive way. They have their opinions also and as an opinion ( right ,wrong or indifferent) they can state them as long as it's based on some type of relevant research. If someone wants to refute a certain opinion, without a personal attack and can back it up with further research that's OK.

3. Although the general feeling in the research community is that a cure or a vaccine is a long way off, there is always the possibility that by doing all this research a breakthrough could occur even by accidentand all those predictions go out the window (read about penicillan).

4. I would also like to know the source of your information concerning funding. There are over 33 million people afflicted with HIV/aids worldwide and although it's considered a "manageable dis=ease" in western countries, that is not the case in most of the world (look at Africa). The funding for HIV is not in the top ten. It seems that way because HIV is a good story an d constantly in the news. My resource for the aforementioned statement is from the NIH:

If you have information to the contrary, I would be happy to discuss/ review it with you if the source is reputable and fact based.

5. As far as research being drastically reduced after a preventative vaccine is found (although this statement will be a hypothetical since a preventative vaccine has not been found yet) I believe that researchers can use HIV as a model to further study the workings of the immune system and other diseases.

We are certainly not in agreement with our visions as to how research is proceding , but I have given you my rebuttal and if you wish to discuss further please reply.

Deep down I think we are all hoping for the same result.. History has been less than kind to those of us suffering from this disease ( the advances not withstanding). Lets all work toward the goal of not having history repeat itself.

I read your link provided. We are certainly in agreement that the data most be further analyzed. However, even if Michael Palm's statistics are proven to be true in the lower range, I know you've got the savvy to understand " A journey of a thousand miles starts with one small step".

There is a very strong bias in this forum toward overly hyping ever scientific advance, no matter how small or inconsequential. Any time someone dares to not go along with the Polyanna happy talk their posts are attacked as "lame, dellusional, pessimmistic" or something simliar.

bmancanfly,

Since you attempted to quote me (albeit with horrendous spelling - is english your first language?) I'll make a couple of comments to your incredibly lame post. You make, as always, many unfounded and unsupported assertions. When called on it you cry like a little girl. Boo freakin hoo. Your conspiracy theory gobblygook is especially annoying.

Please provide links to support your claims of Pollyannas crowing about a cure being "right around the corner". Of course you can't, because no one has.

This is the Research forum, not the Debby Downer forum. No one wants to hear your unsupported ideas.

Since you attempted to quote me (albeit with horrendous spelling - is english your first language?) I'll make a couple of comments to your incredibly lame post. You make, as always, many unfounded and unsupported assertions. When called on it you cry like a little girl. Boo freakin hoo. Your conspiracy theory gobblygook is especially annoying.

Please provide links to support your claims of Pollyannas crowing about a cure being "right around the corner". Of course you can't, because no one has.

This is the Research forum, not the Debby Downer forum. No one wants to hear your unsupported ideas.

Free,

Did you read a word I wrote above about personal attacks? Keep it up and you'll be given a time out.

This is the Research forum, not the Playground forum. If you cannot put your disagreements across in a civil, adult manner, keep them to yourself.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Heh...thanks for the hearty laugh. Pessimistic blowhards, naysayers, and purveyors of "not invented here" are a dime a dozen.

bman, free,

The back-and-forth sniping between the two of you is getting tedious. It stops here and it stops NOW. If you cannot add to the discussion about this vaccine without the sarcastic comments, then DO NOT POST.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Hmmm, well.. i was going to say that topics with titles like "Could this be the Holy Grail" I do find a bit tedious, but that it's really just a few people and in general these forums are fairly sane and very informative... But let's just pretend I didn't say that.

What I REALLY want to say is that the NYT editorial is, as Free said, quite scathing but I have to agree - I can't really find anything wrong with it. I keep turning it over and over in my head and true, I'm not a statistician, but I just can't help but feel that this really isn't statistically significant. I mean how can it be with such an extremely small percentage of such a large group? There are so many factors that could have contributed to the small difference, especially considering that no protection was found from the vaccine.

I know that a lot can be learned from what doesn't work, and I hope that it is. But it seems for now that a new direction in vaccine development has not been proven. As a small aside, I would add that I was a volunteer in the notorious Vaxgen trial in the 90s. We really didn't have any way of knowing if we had taken placebo or vaccine (I ended up having vaccine) and they did give counseling, but it's true that there is a psychological component to this where you can't help but think you MIGHT be protected. After the trial ended (and I read about it failing in the NYT BEFORE the trial center informed me - not the way to make your volunteers happy, by the way) I then found out, again not a peep from the New York Blood Center, that there was a theoretical possibility that the vaccine could make you more susceptible. The whole thing was quite a debacle and I was really freaked. I guess all this to say that I truly appreciate the sacrifice that vaccine volunteers make and that they deserve to be treated with dignity and with only the best that science can provide, be they in Thailand, Africa, Canada or the good 'ole USA.

I don't think they cheated I'm just saying that with some high risk groups, for example MSM there are men on the DL who don't admit to having sex with other men, or people who are sex workers or IV drug users who also don't admit to it. If individuals from the high risk groups were not evenly distributed between the two arms (without the researchers even realizing it) then the results would be skewed one way or the other.

Bottom line is they will be looking at this data with a fine tooth comb, I think it's too soon to really know what the numbers mean.

You're right, these results are a hair's breadth from not being "statistically significant."

This discussion is good, and obviously we all could use some more education in statistical analysis (I have no education in this). Some of the tension here between those who are pessimistic and optimistic may lie as much in the fact that we've never been taught this stuff, as our "nature". Ann's warning is duly noted.

I have never understood statistical "error level". "Significance?" Anyone? It certainly matter if the "two arms" of the study were not equivalent. And that does happen.

Yes, sex workers, or MSM might be a higher risk group than say, older females. But saying that doesn't mean higher risk people need to be excluded from data collection. In fact, it might be very helpful to identify and recruit them. Virgins and monogamous folks wouldn't be the best source for studies on STD transmission, Studies of HIV- prostitutes---their customers are the danger---have been helpful in proving effectiveness of rubbers, for intercourse.

I suppose the bigger the sample and control for location (city vs. rural), age, wealth, educational level, occupation, types of drug use, single or married, gay or ?, gender, access to healthcare, would be example of factors that would be imputed. Few studies try to find subjects who are all equivalent (some twin studies excluded). Identifying relevant differences and then comparing the data this way or that (controlling for one or another aspect) is part of the analysis.

In a dumb sense huge samples are more meaningful than tiny samples. But it is much more complicated than that.

One way to make more of a study is for other researchers to analyze the same data (often just a piece of it). Often the conclusions are somewhat different than the first time around. This is pretty common. It is common to try "replication" of results in hard science, but also common to see the process happen in softer science I just described, if only because it's a whole lot cheaper to look at someone's else's data than design a study and collect your own.

SF State Univ. did a good long term study of gay men who were LTPoz, mostly drug-users, all of whom had unprotected intercourse, and their long-term health. The high risks these men took over many years of study was what made the data meaningful. Ethics dictate study design not encourage participants do themselves harm, but I think my point can be understood. Tuskegee (exposure) can be thanked for progress in ethical study design.

Study participants lie for many reasons, including access to the benefits of trial participation. I was just in a drug trial where I was told what results I needed to report daily to gain access into the longer study and use of a placebo or real med, followed by the real med. That's not honest. I didn't mind the info; I wanted the drug in the study. Incentive to lie!

Good studies build incentives for truthful disclosure and desired behaviors (Drug tests are an example of a useful disincentive). Scientific studies that require NO self reporting of anything are ideal. Sometimes the subjects are ALL dead, and their medical records are combed thru for data.

Knowing males from Town A died on the average 1.5 years before males from Town B might point to the steel furnace in Town A, or maybe it was milk consumption that made the difference. Everyone takes credit when unemployment or crime drops, but points somewhere else when folks lose their jobs or break-ins rise. Cause is hard to pinpoint.

Many studies are poorly designed. Some are tainted based on who is paying the bill. I am not saying either element applies in this vaccine trial.

It helps all of us to learn a little about these processes. I would like to read a good introductory book on the subject of statistical studies, if someone could suggest a title. Many of you have carefully laid out the positive aspects of this vaccine study (Thanks!) , and no doubt you are right this is a step forward. Maybe for those of us with HIV as well.

I feel glad that a vaccine is being achieved for HIV- people, but shouldnt it be more important to discover better treatments or even a cure for this.

Sadly its obvious (at least for me) that we all are going to be forgotten, they are just going to wait for us to die, it kinda depresses me when i read the success of this vaccine, the more success they have, more doomed we are. Why spending rivers of money on researches for a small percentage of people living with HIV, if they know that the disease ends with them.

It helps all of us to learn a little about these processes. I would like to read a good introductory book on the subject of statistical studies, if someone could suggest a title. Many of you have carefully laid out the positive aspects of this vaccine study (Thanks!) , and no doubt you are right this is a step forward. Maybe for those of us with HIV as well.

But basically the problem here is that they used a 19 times out of 20 test to decide whether their results hald water and were awfully close to the edge on the result. If they had used a 99 out of a 100 test, they would have failed. And with so many trials out there, being close to the edge on a 19 out of 20 test may not be good enough.

As we debate the relative positives vs negatives concerning this vaccine, the bottom line is that the data must be studied further. I believe we're all in agreement that this particular vaccine will go no further, however ,if there are benefits to be derived from this study and can be used in other applications thats good. The debate gets tedious when a point is reached whereby more data or information is needed to come to some type of educated conclusion. Speaking for myself, I find that new data on any research topic is stimulating because if I felt myself getting bored on any topic then I simply wouldn't read it. Why that is such a difficult concept escapes me. Sometimes the information presented is difficult to understand which certainly adds to the frustration, however, some don't wish to really understand what is being said and doing the necessary research is too daunting. Most want a quick answer, sought of like wanting a baby without going through labor pains. Funny how that usually never works.

And although that it is not the miracle we have been hoping for for decades - it does seem to be an important step forward.

Who knows, with PrEP medication and microbicides, this type of vaccination might make part of a range of strategies implemented together that could reduce transmission - like between discordant couples - and I spose that's a good thing.

As well as preventative vaccines there is also research toward vaccines that might work against HIV in People living with HIV - so this research will possibly help us all.

Roughly roundabout somewhere in the eighteenth or nineteenth century, Sodomite begat Homosexual out of moral, medical and legal models, bequeathing him Identity, who inbred with Nuclear Family and Industrialism to spawn Homophobia.

Roughly roundabout somewhere in the eighteenth or nineteenth century, Sodomite begat Homosexual out of moral, medical and legal models, bequeathing him Identity, who inbred with Nuclear Family and Industrialism to spawn Homophobia.

The strange thing about this vaccine is that it's not even known how it worked, which is why the whole thing is questionable.

HOW DOES THE VACCINE WORK?

Researchers are not sure. AIDS experts have long agreed that any HIV vaccine would have to activate both arms of the immune system -- the antibodies that home in on invaders such as viruses to neutralize them, and the T-cells that recognize and destroy viruses.

This vaccine did not appear to generate either response, and yet prevented infection 30 percent of the time.

Even more confusing, among the 51 people who were vaccinated but were infected anyway, the virus replicated just as well as it did among unvaccinated HIV patients. Researchers would not have expected that -- they would have expected the vaccine to at least make the infection less serious, as influenza vaccines do, for example.

"Additional studies are clearly needed to understand how this vaccine regimen reduced the risk of HIV infection," said Dr. Jerome Kim of the Walter Reed Army Institute of Research in Maryland, who helped lead the study.

So, you take 16.000,- people (first thing I am missing is in the reports, what age they are, what class they are from, what is their income, etc...) and tell them they get a vaccine (I even don't know, if vaccine is the right word, if you put two meds, which worked rather bad in single tests, together) against HIV (only half, because the other half got placebos) and let them run around and have unprotected sex (protected sex wouldn't make sense, as you want to know if the vaccine works) with everyone in their way. Now, after a timebeing you check them for HIV and found that there is less infection in one group. With less infection, I thought it was about 25%, but I am not hundred % sure. Anyway, that would mean, when I give 50 people over a time of three years a Cola a day and 50 people a glass of water and in the end from the 50 drinking Coke are less infected with HIV, that Coke is a vaccine... No, I don't think so...

There are no reports of how much sex each of these testpersons had and with which kind of people (risk groups, like redlight district, etc...)

For example, if from these two groups of 8.000 in one are around 70%, which frequently visit sexworkers and in the other group the majority of people are faithful partners...how can you ever come to a 'real' conclusion?

Every single testperson must have had the same amount of sex and with basically the same people to get a real result. I also understand that is not possible, but anyway the data they released dosn't show proper statistics for me to jump up and open a bottle.

There is a reason, that Americans conduct their tests in a country like Thailand, which still is a third world country despite them claiming they are not. Not that I condem Thailand, as it is very ambitious with their Red Cross HIV Resaerch Project, but still, things going here to the press might not be everytime entirely true.

Also, I have strongly to agree with bman. As he steted, if there is a vaccine, there will be no need for a cure for all the effected ones (including me), as there is no need. And the line from Mystery "...but death kinda has a natural way of curing things." might be our faith.

Also the mentioning from freewillie99, that his optimism is based on the ever increasing rate of technology and advances in areas not even in existence 10 years ago (plotting the genome, gene manipulation, gene silencing, medications with little to no side effects, identification of the reservoirs where HIV hides and advances towards eradication of these, etc) is completely right, but all the technology and money (imagine the money saved, if there is no real need for a cure, because the uninfected - what a strange word to use - and future generations are protected through a vaccine already) will go in other research and not HIV. And we all know that there are other illnesses in the line to be 'cured'.

And it would be convenient too. Besides the saving of millions of $ - and I mean millions!!! - it is a chance to reduce our world population a little without implementing drastic measures. And we all know, we are too much here on this small planet, don't we...??

So, just go on with your lifes, enjoy it as much as possible and when the times come, it comes... Better having a short life lived in a satisfactory and exhausting lifestyle, than sitting at home, hoping nothing happens to one and wait for the 'cure'...

An unrevealed second analysis of the results from the initially lauded RV 144 HIV vaccine trial failed to show a statistical benefit over placebo, according to a ScienceInsider blog entry authored by longtime AIDS journalist Jon Cohen.

Lead scientists from the RV 144 trial conducted in Thailand announced last week that there was a modest reduction in the HIV infection rate among those who received the vaccine. The results were heralded as a triumph by the general media, but were greeted with measured caution by some vaccine experts.

The skeptical experts pointed to the extremely narrow margin of efficacy. While the vaccine reduced the risk of HIV infection by 30 percent, only a handful of volunteers in the massive 16,000-patient study—51 patients in the vaccine group compared with 74 patients in the placebo group—actually became infected during the study, lending to a difference that was just barely statistically significant.

There were also concerns about the fact that the vaccine failed to suppress viral loads in those who did become infected, with experts arguing that a vaccine capable of sparking the immune system to prevent HIV infection would help control HIV replication if infection did occur.

However, some expressed hope that while the vaccine itself would never be approved with such a low rate of success, it might point the way to other more successful preventive vaccines.

Now Cohen reports that a second analysis showed a trend toward benefit in those who were vaccinated, but failed to demonstrate a statistically significant difference. This means the difference was small enough that it could have occurred by chance.

The initial report was based on an intent-to-treat analysis that included all trial participants, including people who may not have received all of the vaccinations or who may have dropped out early. The unrevealed second analysis was per protocol, and only included people who received all their vaccinations on schedule.

According to Cohen, the per-protocol analysis failed to demonstrate a statistically significant difference between the two groups of patients studied. The vaccine efficacy also dropped slightly—a confusing finding, given that a tested vaccine often performs better in per-protocol analyses, given that it eliminates people who weren't properly vaccinated and might not have developed an appropriate immune response to the virus.

This new analysis, said the researchers interviewed by Cohen, casts some doubt on the possibility that the vaccine approach employed in the RV 144 study will have any positive influence on HIV vaccine development.

Logged

"Hope is my philosophy Just needs days in which to beLove of Life means hope for meBorn on a New Day" - John David

Protection could have occured by chance (or not), and even if it did not, they don't know why the vaccine worked, and don't know why the peope it didn't work for got HIV (or were they the ones not following the correct protocol?)... hmmm

I await further presentation of the data befor I fold my deckchair up (as ever)

those involved in this trial don't want to accept that it was more a failure than a success and believe me or not this is good news because once the scientific community understands that a preventive vaccine is out of reach they need to speed up for a therapeutic one if they want at least partially stop the disease. this is also necessary due to the astronomic costs of treatment which are unsustainable in the long term. i strongly hope that hiv will be like herpes in the near future or simply a harmless virus in our bodies. we need to tell our immune system how to manage the virus without therapy. once this is archieved eradication shouldn't be necessary.

« Last Edit: October 12, 2009, 04:07:09 PM by xman »

Logged

sign the petition launched by the aids policy project addressed to the nih aimed to increase the money needed to find the cure:

Sadly its obvious (at least for me) that we all are going to be forgotten, they are just going to wait for us to die, it kinda depresses me when i read the success of this vaccine, the more success they have, more doomed we are. Why spending rivers of money on researches for a small percentage of people living with HIV, if they know that the disease ends with them.

Is it only me, who sees things this way?

i disagree. there are more companies investing in therapeutic approaches since this is the more feasable way to combat the disease.

Logged

sign the petition launched by the aids policy project addressed to the nih aimed to increase the money needed to find the cure:

sorry to hijack this lovely discussion of whether or not we will be forgotten if and/or when a preventative vaccine is developed, however pertinent that may be, but does anyone know which proteins this one targeted other than gp120? I'm wondering because Geovax made all their "we will definitely work because we are similar to this one but better" noises and now that the Thai vaccine is turning out to be pretty much nothing on second analysis, I am wondering how that might relate to Geovax, which is in some ways similar but targets gag, pol and env, if I am not mistaken. Of course they have not commented on the follow-up analysis.

My knowledge of how these things work is so low-tech that I might be completely missing the boat and I suspect Geovax was just trying to jump on the hype band wagon, and in fact it may be that they are completely different. would love some insight on this from those with more technical knowledge than me.

thanks Matt.Geovax is supposed to express Gag, pol and env delivered in an MVA (as opposed to canary or other fowlpox virus) along with a DNA primer. To my lay understanding, it sounds different enough that I won't worry too much about similarity to the Thai vaccine. But I really think it's time to give up on gp120... I believe Aidsvax was also used in the Vaxgen trial I participated in in the 90s. And we all know how that came out.

Actually, gp 120 is a very attractive target because it is expressed on all hiv strains and is constant. I believe the difficulty is in mounting a strong enough immune response to get at that target. See: